Ch 1. Overview of professional med surg nursing concepts

A nurse participates as part of a quality improvement (QI) team to develop a plan to "reduce deep vein thrombosis on a surgical unit." What part of the PICO(T) question does this statement represent?

O O stands for Outcome that is desired as a result of the work of the QI team.

The nurse provides client-centered care for an older client who was admitted from an assisted living facility. What attributes would the nurse demonstrate when providing care for this client? (Select all that apply.)

-Physical comfort -Emotional support -Client respect -Communication and education -Care coordination -Transition and continuity of care All of these choices are attributes of client-centered care. Respect for all individuals is especially important.

The nurse is interviewing a transgender client about sexual orientation, gender identity, and health care. Which questions are appropriate as part of the interview? (Select all that apply.)

-"Have you disclosed your gender identity and sexual orientation to your primary health care provider?" -"If you have more than one sexual partner, how are you protecting both of you from infections?" -"Do you have sex with men, women, both, or neither?" -"Are you in a relationship with someone who lives with you?" All of these questions are culturally sensitive and respectful to the client with the exception of option C. The nurse would not judge the client and assume that the client is having "problems."

Which principal nursing actions best support a focus on client safety? (Select all that apply.)

-Preoperative checklists -Handwashing -Five rights of drug administration Handwashing is the number-one way to prevent infection in clients. Checklists can help prevent mistakes in care for a surgical client, thus ensuring a safe environment. Adhering to the five rights of medication administration helps to prevent errors in this important nursing care activity, providing for increased safety in client care. Although restraints may help clients who are confused to keep from hurting themselves, they are potentially risky and are used infrequently because of the harm they can cause. Respect is an important element in client care, but it is not directly tied to the provision of a safe care setting.

Which nursing action demonstrates use of the principle of justice?

A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer. The principle of justice refers to equality—all clients should be treated equally and fairly, as demonstrated by the respect shown to the client with dementia. The 32-year-old's fall prevention relates to providing a safe care environment, which is an important nursing principle but is not categorized as justice. Providing the 82-year-old client access to the hospital Patient Advocate is an example of the principle of self-determination through facilitation of the client's autonomy. Including the parents of the 13 year old in the discussion about care represents an example of dependent care, not the principle of justice. Teens may not legally be empowered as the final decision makers in their own care.

When developing a standardized plan of care for clients with a diagnosis of pneumonia, how does the nurse find the best information about providing optimal nursing care?

Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia. The best evidence-based nursing practice will be developed by using information from randomized controlled studies testing the impact of various nursing interventions on outcomes for clients with pneumonia. This type of data collection is the most scientifically based approach listed here. Articles in nursing magazines are likely to be researcher biased. They are also unlikely to be controlled. Chart review serves as a limited source of data and cannot be generalized for a standard. Also, regional practices may tend to skew the data. Data from nurses, although valuable, are likely to be biased; data collection would not be well controlled.

Which of these hospital staff members will the nurse manager request to coordinate the discharge of a client who will need community-based rehabilitation services after a traumatic injury?

The nurse responsible for the client's case management The case manager role includes coordination of acute care and postdischarge community services for the client. The physical therapist, health care provider, and unit-based RN will have input into planning for rehabilitation for the client, but are not the best choice to coordinate a smooth transition from acute care to community rehabilitation services.

Bedside (point-of-care) computers are an example of informatics used in health care primarily for which purpose?

Documenting interprofessional care The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interprofessional care. Computers may be located at the client's bedside or in a central area for ease of access for documentation. Computers allow quick communication among health care professionals to enhance collaboration and coordination of care; however, this type of communication typically would not take place at the client's bedside. Bedside computers in the health care setting are not intended for client use. The Internet provides ways to search multiple sources of information and retrieve data efficiently; however, this would not be done at the client's bedside.

The nurse requests a conference with members of the interprofessional health care team regarding care for a complex client. Which Interprofessional Education Collaborative Competency does this request represent?

Interprofessional Communication The competency of Interprofessional Communication is the ability to communicate with patients, families, and other health professionals in a way that supports a team approach to maintaining health and managing health problems. Values/Ethics relates to respect for the health care team, Role-Responsibilities uses knowledge of one's own role to manage patients, and Teams and Teamwork involves actual delivery of care with the health team.

A nurse gives report about a client whose pain in uncontrolled and suggests that the client receive continuous analgesic administration rather than PRN analgesics. Which step of the SBAR hand-off report is the nurse using?

R R stands for recommendation or request for a new modality or treatment to better manage the client's problem.

As a result of work completed by a quality improvement (QI) team, a new nursing protocol for preventing catheter-associated urinary tract infections (CAUTIs) is piloted. Which step of the PDSA QI model is associated with this action?

S P stands for Plan, D stands for Do, S stands for Study, and A stands for Act. Piloting a new protocol would occur during the S step so that the QI team could test it for effectiveness before adopting it as standard policy.

The nurse supports the client and family in deciding on a "Do Not Resuscitate" order. Which ethical principle that guides nursing clinical decision making is demonstrated in this situation?

Self-determination Self-determination refers to the idea that clients are autonomous individuals capable of making informed decisions about their care. When the client is not capable of self-determination, the nurse is ethically obligated to protect the client as an advocate in the professional scope of practice. Beneficenceemphasizes the importance of preventing harm and ensuring the client's well-being. Justice refers to equality (i.e., all clients should be treated equally and fairly). Legality is not one of the ethical principles.

What does the nurse recognize is the fastest growing technology being used for informatics?

Telehealth and telenursing Expanding telehealth (including telenursing) is a goal for Healthy People 2030 and is expanding globally to meet the needs of many clients in a cost-effective manner.